Dr. Andre Gomes is a leading vitreoretinal specialist from Brazil. He studied medicine at Santa Casa de São Paulo School of Medicine, did his Retina Surgical Fellowship at University of California, Irvine USA and his PhD in Ophthalmology at University of Sao Paulo, Brazil, where he currently is Collaborator Professor. Dr. Gomes is now a vitreoretinal surgeon at the Real and Meritorious Portuguese Charitable Association in São Paulo and Head of the Clinical Ocular Surgery Center of the Suel Abujamra Research Institute in São Paulo, as well as a Committee Member of the same Research Institute. He also regularly presents at specialist, international ophthalmology meetings and conferences across the world. Dr. Gomes was also, until recently, the President and member of the Advisory Board of the Brazilian Retina and Vitreous Society, Board Member and International Representative of the American Society of Retina Specialists, and Board Member of the Retina World Congress.

What do you think of Vitreq’s offer?

I have been working in vitreoretinal surgery for over 25 years. I know all the guys involved with Vitreq. They have a track record in producing instruments that are well-refined and reliable. Vitreq’s instruments are durable, refined, precise, and also cost effective. There is an array of disposable and non disposable instruments: both types of Vitreq products are well-designed and well-made. I think that is important. The full array of instruments covers most surgical needs, even for specific situations, such as longer eyes, like myopic eyes, for example, that are more challenging for the surgeon to reach parts of the eye with standard instruments of a regular length. Vitreq came up with a specific, different type of instrument for that. Vitreq always try to develop and add new products to their range based on advice that they have gathered from many well-known and less well-known retina specialists from all over the world. They have a global view, not a local view, of how surgeons deal with procedures. So, with their input from this perspective, they can come up with a different set of instruments dedicated to specific maneuvers in VR surgery.

Which instrument or procedure currently proves the most challenging to you in your daily practice? And what could be improved?

I have been working in VR surgery and involved in training future VR surgeons for the past 25 years. Tough cases of retinal detachment and diabetic retinopathy are among the most difficult procedures. It is also more difficult to teach and for students to acquire experience when it comes to very severe proliferative diabetic retinopathy cases and also some PVR retinal detachments. Even though macular surgery is very delicate, it is relatively easy to teach, even though the learning curve might not be as steep as you might want.

What experience have you had of working directly with companies to develop new instruments and/or surgical techniques? What are the benefits and/or limitations of working directly with companies?

Living in Brazil, this is not easy, because exchanging information and prototypes under development through customs isn’t straightforward, but I think that it is still important. I have designed many forceps and scissors that have been very successful. I think it is so important to persevere with ideas, because of the difficulties that surgeons’ face in certain maneuvers or specific procedures and in talking to students and exchanging information with them, you can find many new ideas. It would be wonderful to have a direct channel with a company – a sort of ‘hotline’ that you could use. Or maybe exchange emails with information based on the difficulty that you just faced and the idea that popped into your mind, so you could get a very fast turnaround and when it comes to new innovations. I think that is one of the keys to success for companies these days – having fast R&D that can speed things up, when it comes to developing new instrumentation or new machines. It is something you often don’t have with big companies. And it is essential. This sentiment is shared by many from the retina community from all over the world. They would love to have that opportunity. Maybe there are some not very well known retina specialists in our field that are brilliant guys with brilliant minds, but they just don’t have access to the right direct channel or the right pathway to realize their idea.

What do you expect to see developing in the future (e.g. the next 3-5 years) in VR surgery?

We have entered the small gauge surgery era. We can accomplish better results now, because the technology has evolved so much. We have many new tools and machines, now, but continued commitment to R&D is very important. Not every single idea will be used, but many will, and some new tools could be very useful indeed. If a company doesn’t have those ideas and doesn’t have a well-developed R&D department, it will not achieve much. We have new ideas on a daily basis. Personally, I am interested in development of a new, cost-effective, vitrectomy machine that cuts well and is optimally controllable via a very nice foot paddle. Today, with the technology that we have - dual cutting type blades and fluid flow control – we can work closer to the retina without too much traction, and we have smaller gauge instruments that are less flexible. We are getting smaller and smaller and narrower and narrower with trocars and new 27 gauge instruments. Even though most surgeons don’t use 27 gauge today, because it takes longer, maybe if we can modify that in the future and have smaller gauge instruments working as fast as the old versions of thicker instruments.

Improving view is also important. Cost effective, wide angle viewing systems that can be adapted to brand or microscope would also be nice. And new liquids that you could use in the eye, such as new dyes, would be useful, but not only the dyes and fluids per se, but a controlled injector to use with those fluids, so that you don’t cause a jet stream over the retina. This can cause damage to either the retina or the underlying tissue. If you use a syringe and the hub is not moving gently enough, the dye jet streams and can reach underneath the retina, causing some toxicity.

What are your own priority focus areas for the next few years- either in research or clinical practice?

We have a very large Retinal Society in Brazil, and when we conduct surveys and ask about VR surgery, we see a major difference between teaching institutions and private institutions. Teaching institutions usually are provided with high end machines. That is more difficult for smaller practices. Brazil is a large country. We have over 900 retina specialists registered to our Society and I think they would love to have the opportunity to have high-tech, new machines, but more affordable machines that might not be as sophisticated as the ones that the teaching institutes might use, but with the basics that allowed them to provide the same quality of care as the other institutions. If you think about a vitrectomy machine: high speed, or a more controllable, cutting machine, with a nice foot pedal, and consumables that are actually affordable. You don’t have to have a machine with that many computers inside. They are exciting, but you don’t actually use most of those features. For instance, you buy a top-of-the-range car and you might have seven memories on your seat, but you never use them …maybe you use one or two? …One for you and one for your wife? …and the rest are just redundant. These redundant features add costs. So, all you might need are a great pump in the machine, a good paddle, and a fine screen and fluidics. Maybe costs can be saved with development of machines like those. I would say the same with instruments. A broad array of disposable instruments for some markets, but also reusables that are cost effective would be a sound strategy.

What do you envisage Vitreq’s role in the market to be?

I think they still have an open field to evolve in. I know how determined and how brilliant the minds of the people involved in Vitreq and their projects are. I think the market is hungry for new companies, who are driven to provide good instrumentation, good vitrectomy machines and consumables. We can’t wait for them to compete directly with the major players that we currently have on the market. Vitreq have the ‘know-how’ and determination, and I wish them luck!